SIPTU is calling for more accountability in the management structures of the health service.
The union says there can never be effective reform of the service until everyone in the chain of command is answerable for their actions.
The comments come as the new Health Service Executive prepares a plan of action to overhaul local structures around the country.
SIPTU spokesman Oliver McDonagh said: "When things are not done properly, people must be accountable.
"If you're a worker out there in the health service, you're accountable for your actions. If you're a nurse, you can find yourself being struck off the register, you can find yourself being dismissed.
"As far as I'm concerned, there doesn't seem to be any accountability for senior management or for government ministers or for other people who simply mess up."